The thyroid gland is located in the lower part of the neck, below the larynx. It is made up of two lobes located on either side of the trachea and joined by an anterior horizontal portion called the isthmus.
The presence of a lump in the neck, or a compression, may indicate the existence of a thyroid nodule. These nodules are very common and benign in more than 90% of cases.
Surgery is frequently used to treat thyroid nodules, whether benign or malignant (thyroid cancer).
The indication for surgery is generally related to:
- The size of the nodule(s).
- The result of the fine needle aspiration of the nodule (s).
- The existence of a functional impairment.
- The existence of lymph nodes that are palpable or discovered on ultrasound in the neck.
The surgical procedures performed on the thyroid are:
- Lobectomy: removal of a single thyroid lobe.
- Lobo-isthmectomy: removal of a lobe and thyroid isthmus.
- Isthmectomy: removal of the thyroid isthmus.
- Total thyroidectomy: removal of the entire gland (2 lobes).
- Lymph node dissection: removal of the lymph nodes located near the thyroid.
Thyroidectomy is performed under general anesthesia with the help of thyroid surgical instrument set and orotracheal intubation for ventilation of the patient.
The incision is horizontal, quite low at the neck.
An intraoperative analysis of the nodule (s) can in certain cases make it possible to know their nature.
The procedure takes one to two hours and does not cause any noticeable blood loss.
It presents risks of complications:
Complications common to any surgical intervention (frequency <5%).
Hematoma: may occur within hours of surgery and may require reoperation for drainage.
Abscess: occurring several days after the operation, which may require local drainage.
Complications specific to thyroid surgery
They are linked to the presence behind each of the lobes of the gland:
- From the ipsilateral vocal cord nerve (recurrent nerve).
- Parathyroid glands (regulators of calcium metabolism).
The surgical act has little impact on the general condition, causes little local pain (pharyngeal discomfort comparable to sore throat) generally easily calmed by usual analgesics. It sometimes requires the placement of a small, uncomfortable drain for 24 to 48 hours.
The skin healing is generally of good quality, and does not acquire its final appearance until after a period of about 6 months. This scarring can be hypertrophic (formation of a small red bead causing itching), especially in young people. This is usually easily treated with cortisone cream or local infiltration.
Likewise, edema of the operating area can persist for 1 to 3 months and be a source of local discomfort, usually moderate. The skin on the neck and / or the anterior part of the chest may remain unresponsive for a few weeks before returning to normal.
Lymph node dissection
Intraoperative analysis of the nodule (s) guided by preoperative fine needle aspiration can lead to the diagnosis of cancer (approximately 5% of isolated nodules).
Thyroid cancers can spread to the lymph nodes in the neck, either in the central compartment of the neck, around the thyroid and trachea, or in the lateral region of the neck (the jugulocarotid region) unilaterally or bilaterally, even in these 3 ganglionic regions.
In the event of a pathological lymph node (one speaks of “lymph node metastasis”) or suspect, dissection is always indicated; in the absence of a suspect lymph node, preventive (or “prophylactic”) dissection of the central compartment and the lateral compartment on the side of the thyroid cancer can be performed. This preventive dissection has the advantage of knowing precisely the extent of the cancer and of adapting the complementary treatment (radioactive iodine and L-thyroxine) accordingly.
Preventive dissection is done through the same incision as that created for the thyroidectomy, and at the same time of operation. A larger incision in the lateral part of the neck may be necessary in case of more extensive dissection (especially in the case of pathological lymph nodes). Scarring is the same as for a simple thyroidectomy, but the swelling and numbness of the neck may be more extensive, as may the muscle pain in the neck, moderate and transient.
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